Is NC ready for this month’s ACA ruling? Report says no

Even with almost half a million residents’ health coverage at stake, North Carolina has done little to prepare for the possibility that the Supreme Court could end Affordable Care Act subsidies this month, a report from Health Affairs Blog says.

“As late as March 2015, many legislators were unaware that subsidies were at risk. Awareness of the issue has percolated within the legislature following oral arguments in King, but legislators have not publicly discussed contingency plans,” five authors wrote this week. “As Governor McCrory recently said, ‘There’s no B plan by either the federal government or the states.’”

The blog is produced by a Maryland-based journal on health care policy and research. With a grant from the Commonwealth Fund, it studied five states that stand to lose subsidies if the court rules in favor of the King v. Burwell plaintiffs, who are challenging the legality of subsidies in 34 states that didn’t set up their own exchanges to provide federal subsidies that help people afford private health insurance. A ruling is expected by the end of June.

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“From late March through early May, we spoke with between seven and fifteen people from each state, reaching out to gubernatorial advisers, legislators and their staff, agency officials, insurers, hospital associations, and consumer advocates. In exchange for their candor, we do not reveal any identifying information without explicit permission,” the authors wrote.

In North Carolina, they concluded, “very little work has been done to plan for an adverse decision in King.” But they added that interviewees were “somewhat optimistic that North Carolina would move to create a state-based exchange.”

Gov. Pat McCrory and moderate Republicans in the state House show some openness, they concluded, while Senate President Pro Tem Phil Berger “has so far remained conspicuously silent.”

The report includes an interesting note on the geographic politics of health care: “A stark urban-rural divide runs through North Carolina politics; Democrats are aligned with the cities and Republicans with rural areas. A major source of resistance to the ACA’s Medicaid expansion is the perception that it would mainly benefit urban residents. Although exchange enrollment is somewhat higher in urban than rural areas, the disparity is not enormous. (Approximately 23 percent of exchange-eligible residents in urban areas enroll, as compared to about 15 percent in rural areas.) Rural Republicans may be unable to sustain resistance to the exchanges if their own constituents are clamoring for tax credits.”